Mehran Rostami - MSc, MPH, Deputy of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
Abdollah Jalilian - PhD, Department of Statistics, Razi University, Kermanshah, Iran
Seyed Amirhosein Mahdavi - MD, Legal Medicine Research Center, Iranian Legal Medicine Organization, Tehran, Iran
Nasser Bagheri - PhD, Health Research Institute, University of Canberra, ACT ۲۶۰۱ Australia

Background: The suicide incident has had an increasing trend in Iran over the past years. This study mainlyaimed to investigate and visualize the spatial variations of registered suicide cases at the province level. Atwo-step modeling approach was employed in order to estimate the relative risks (RRs) and model the ageof fatal suicide across provinces in Iran.Study design: An applied ecological study.Methods: This study used the suicide death data recorded by the Iranian forensic medicine organizationfrom March ۲۱, ۲۰۱۶, to March ۲۰, ۲۰۱۸. Furthermore, a Bayesian spatial approach - Besag, York, andMollie (BYM) model- was applied to estimate the RR of suicide across provinces in Iran.Results: This risk was found to be significantly higher than the average in both men and women in thewest of Iran. For women, higher population density (mean: ۰.۰۰۳; ۹۵% CrI: ۰.۰۰۱-۰.۰۰۵) and lowerurbanization rate of provinces (mean: -۰.۰۲۵; ۹۵% CrI: -۰.۰۳۸, -۰.۰۱۲) were associated with increased RRof suicide. Based on the log-normal model fitted to the data, the overall mean age of the fatal suicide atthe national level was ۳۴ years.Conclusions: The magnitude of gender and age differences was quantified, and many spatial variationswere identified in suicide mortality across provinces in Iran. Given the heterogeneity in suicide mortalityrisk among different subgroups of age and gender, our findings point to the urgent need in developinggender- and age-specific suicide prevention strategies. Moreover, efficient allocation of healthcareresources for suicide prevention can be attained by targeting provinces with higher risk.

Completed suicide, Mapping, Spatial distribution,Iran